Alcohol consumption and breast lesions: targets for risk-based screening in high-risk Italian women

Background: Breast cancer in Italy is still the most frequent cancer among women, and alcohol consumption is recognized as a risk factor for its development. Overall, in 2020, approximately 10% of all breast cancer-related deaths were attributable to alcohol consumption. Despite advancements in diagnostics and therapeutic options reducing mortality trends, the incidence of breast cancer is projected to rise in Italy. This study aims to assess how alcohol consumption influences the timing of breast lesion diagnosis. Understanding these associations can enhance primary prevention strategies and support the adoption of a risk-based prevention approach, integrating lifestyle factors into personalized screening programs. Methods: P.I.N.K. (Prevention, Imaging, Network and Knowledge) study collected data on a prospective dynamic cohort of women who voluntarily underwent breast cancer screening at breast centers throughout Italy, between 2018 and 2023, outside the free national screening program. The occurrence of breast lesion diagnosis and baseline information were collected through clinical visits and an auto-administered questionnaire, including data on absent, moderate or high alcohol consumption during the last 12 months and smoking. 3774 women (mean age 58.9 ± 10.0, range 40-98 years) were included in the present analysis, encompassing women with a suspected or confirmed diagnosis of benign or malignant tumor and healthy women that contributed at least 4 years to the study. An Event History Analysis was carried out to evaluate the effect of alcohol consumption on the timing to event. The event was represented by the transition of the health status, from not diagnosed to diagnosed with breast lesion. The Accelerated Failure Time parameterization was used to directly interpret how the covariates influence the time to the event. The model was adjusted by familiality of breast/ovarian cancer, marital status, level of education, and type of access to health care. Results: High alcohol consumption exhibited an accelerating effect on the transition to the diagnosed state, indicating a significantly shortened time to event: β coefficient - 0.33 (p-value 0.010) in the adjusted model, indicating an anticipation of about 4 months. The effect of moderate alcohol consumption did not reach statistical significance, neither in the unadjusted model nor in the adjusted model. Adjustment for smoking status led to a further increase of the β coefficient for high alcohol consumption (- 0.40; p value 0.003) and brought moderate alcohol consumption closer to statistical significance (β - 0.15; p-value 0.087). Familiality of breast or ovarian cancer showed a statistically non-significant accelerating effect, while marital status different from maiden, high education, and private access to health care showed decelerating effects. Conclusions: High alcohol consumption was confirmed as an accelerating factor in breast lesions diagnosis, while the effect of moderate consumption did not reach statistical significance. These results help identifying actionable targets for high-risk populations, emphasizing personalized risk-based screening programs and gender-sensitive interventions.